ECG Guru - Instructor Resources - Pre-excitation https://www.ecgguru.com/ecg/pre-excitation en Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome https://www.ecgguru.com/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/13M%20SVT%20WPW%20ECG2%20don%27t%20know%20time.jpg" width="1800" height="1141" alt="" /></a></div><div class="field-item odd"><a href="/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/image_2.jpg" width="1800" height="1141" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">This ECG was obtained from a 13-year-old boy who had previously been in NSR. &nbsp;At that time, he was diagnosed with <a href="http://ecgguru.com/ecg/wolff-parkinson-white-syndrome-0">Wolff-Parkinson-White syndrome</a>, and he had delta waves.&nbsp; He now presents with a supraventricular tachycardia.&nbsp; People with W-P-W have one or more accessory pathways which allow atrial impulses to bypass the AV node and “pre-excite” the ventricles.&nbsp; An accessory pathway, along with the normal pathway through the AV node, can form a functional circuit, allowing conduction to proceed down one pathway and return up the other, in a rapidly repeating circular motion.&nbsp; This causes paroxysmal supraventricular tachycardia.<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 8pt;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">In W-P-W, the most common type of SVT is AV reciprocating tachycardia (AVRT), also called AV reentry tachycardia.&nbsp; Conduction through the accessory pathway can be forward (anterograde) or backward (retrograde).&nbsp; The most common type of reentrant conduction in W-P-W is <strong>ORTHODROMIC</strong>, which we see here.&nbsp; The impulse conducts forward through the AV node, and backward over the accessory pathway.&nbsp; There is no delta wave, as there is no pre-excitation of the ventricles.<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 8pt;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong>Features of orthodromic AVRT are: </strong></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Fast rate (usually approximately 140-250 beats per minute) &nbsp; &nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Narrow QRS complexes (unless BBB or IVCD present) &nbsp;&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">P waves retrograde, if seen (negative in II, positive in aVR and V1) &nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">ST depression and T wave inversion common.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px; line-height: 1.538em;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">W-P-W is often diagnosed in children and teenagers.&nbsp; Treatment depends upon the hemodynamic stability of the patient during episodes of SVT.&nbsp; Catheter ablation can be used to disable the accessory pathway in many cases.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">*. The second image has been added to accompany Dr. Ken Grauer's comments below.&nbsp;</p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/612/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 1/5</option><option value="40">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 2/5</option><option value="60">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 3/5</option><option value="80" selected="selected">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 4/5</option><option value="100">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.8</span></span> <span class="total-votes">(<span >5</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-_xSxv0l-rfMZF1TPXdOX4H7Vhsnkk30mqWuWvSE82R4" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/pediatric-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pediatric ECG</a></div><div class="field-item odd"><a href="/ecg/wolff-parkinson-white-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White syndrome</a></div><div class="field-item even"><a href="/ecg/w-p-w" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">W-P-W</a></div><div class="field-item odd"><a href="/ecg/wolff-parkinson-white" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White</a></div><div class="field-item even"><a href="/ecg/supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supraventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/svt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">SVT</a></div><div class="field-item even"><a href="/ecg/avrt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AVRT</a></div><div class="field-item odd"><a href="/ecg/av-reentry-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV Reentry Tachycardia</a></div><div class="field-item even"><a href="/ecg/reciprocating-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Reciprocating tachycardia</a></div><div class="field-item odd"><a href="/ecg/pre-excitation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pre-excitation</a></div><div class="field-item even"><a href="/ecg/accessory-pathway" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Accessory pathway</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fsupraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome&amp;title=Supraventricular%20Tachycardia%20in%20Pediatric%20Patient%20With%20Wolff-Parkinson-White%20Syndrome"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Tue, 01 Dec 2015 17:34:39 +0000 Dawn 679 at https://www.ecgguru.com https://www.ecgguru.com/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome#comments Wolff-Parkinson-White Syndrome https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/wolff-parkinson-white-syndrome-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/PreEx%20WPW.jpg" width="1800" height="1245" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">Here is a good example of an ECG showing the signs of Wolff-Parkinson-White syndrome during normal sinus rhythm.&nbsp; WPW is one of the “pre-excitation” syndromes caused by an accessory pathway between the atria and ventricles. Accessory pathways can bypass the AV node.&nbsp; These conduction pathways can conduct anterograde (forward toward the ventricles), retrograde (away from the ventricles), most commonly, in both directions.&nbsp; When the accessory pathway conducts in an anterograde fashion, it causes pre-excitation of the ventricles. See <a title="WPW conduction C Watford" href="http://ecgguru.com/heart-illustrations/accessory-pathway-conduction-compared-normal-conduction"><span style="color: #0070c0;">Illustration</span></a>.</p><p class="MsoNormal">Wolff-Parkinson-White syndrome is caused by an accessory pathway called the Bundle of Kent, which can occur on either the left or the right side of the heart.&nbsp; The ECG sign of the pre-excitation of the ventricles in WPW is a <strong>DELTA WAVE</strong>. &nbsp;The delta wave is seen in normal sinus rates when the accessory pathway conducts anterograde, pre-exciting the ventricles. The delta wave arises at the end of the P wave, eliminating the PR segment in some leads.&nbsp; In this ECG, the delta waves can best be seen in Leads I, II, aVR, and aVL, as well as in V1, V2, and V3.&nbsp;</p><p class="MsoNormal">People with WPW are prone to bouts of supraventricular tachycardia, called AV reentrant tachycardia (AVRT).&nbsp; A circular pathway can form between the normal AV pathways and the accessory pathway, causing an impulse to depolarize the ventricles and return to the atria in a rapidly repeating cycle, causing a paroxysmal supraventricular tachycardia. The delta waves will disappear as they become part of the reentrant cycle.</p><p class="MsoNormal">Tachyarrhythmias can also form when impulses from atrial flutter or <a title="Pre-excited a fib Jason Roediger" href="http://ecgguru.com/blog/jasons-blog-ecg-challenge-week-dec-16th-23rd"><span style="color: #0070c0;">atrial</span> <span style="color: #0070c0;">fibrillation</span></a> rapidly enter the ventricles through the accessory pathway without the filtering effect of the AV node.&nbsp; The extremely rapid rates produced in these situations can quickly lead to deterioration and ventricular fibrillation.</p><p>&nbsp;</p><p class="MsoNormal">For more information on WPW ECG signs, we recommend <span style="color: #0070c0;"><a title="WPW Life in the Fast lane" href="http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/">Life In The Fast Lane</a>.&nbsp;</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/612/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Wolff-Parkinson-White Syndrome 1/5</option><option value="40">Give Wolff-Parkinson-White Syndrome 2/5</option><option value="60">Give Wolff-Parkinson-White Syndrome 3/5</option><option value="80" selected="selected">Give Wolff-Parkinson-White Syndrome 4/5</option><option value="100">Give Wolff-Parkinson-White Syndrome 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-cfx7_gbiQ6-faS1n6MhHfkkjVzm26Wnb2-moe5DMJTw" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/wolff-parkinson-white" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White</a></div><div class="field-item odd"><a href="/ecg/wolff-parkinson-white-pattern" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White pattern</a></div><div class="field-item even"><a href="/ecg/pre-excitation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pre-excitation</a></div><div class="field-item odd"><a href="/ecg/delta-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Delta waves</a></div><div class="field-item even"><a href="/ecg/wolff-parkinson-white-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White syndrome</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fwolff-parkinson-white-syndrome-0&amp;title=Wolff-Parkinson-White%20Syndrome"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Wed, 21 Oct 2015 04:05:28 +0000 Dawn 671 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-0#comments